Abdominal Cocoon Syndrome Research Articles

Accurate definition and management of idiopathic sclerosing encapsulating peritonitis.

To review the literature on idiopathic sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome. The PubMed, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters to the editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. The literature search yielded 73 articles on idiopathic (primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India (n = 21), Turkey (n = 14), China (n = 8) and Nigeria (n = 3). The four countries that reported the greatest number of cases were China (n = 104; 53.88%), India (n = 35; 18.13%), Turkey (n = 17; 8.80%) and Nigeria (n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients (range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65 (43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis (one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy (n = 2) and immunosuppressive therapy (n = 1). Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standard management strategy.

Abdominal cocoon: A rare cause of acute intestinal obstruction

Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction resulting from encasement of variable lengths of bowel by dense fibro-collagenous membrane. The idiopathic cases of SEP, which lack any identifiable cause from clinical, radiological and histopathological findings, are also reported under the descriptive term “abdominal cocoon syndrome”. Patient with SEP present with intestinal obstruction. Persistent untreated SEP may advance to bowel gangrene or intestinal perforation, which are life threatening conditions. We report the rare occurrence of SEP in a 45-year-old male presenting with signs of intestinal obstruction. Imaging findings revealed abdominal cocoon with bowel gangrene leading to perforation and the same was confirmed at surgery. Surgical excision of the fibrotic sac encasing the bowel, resection of gangrenous bowel segment and end ileostomy were performed. Histopathology of the excised membrane confirmed the diagnosis of SEP. Radiologists should be aware of this relatively rare cause of intestinal obstruction, its imaging findings and complications, as an accurate preoperative diagnosis will prevent diagnostic delay and aid the surgeon in planning treatment.

143. Abdominal cocoon syndrome secondary to peritoneal venous shunt used to treat breast cancer ascites: What you and your dog might want to know about tamoxifen

143. Abdominal cocoon syndrome secondary to peritoneal venous shunt used to treat breast cancer ascites: What you and your dog might want to know about tamoxifen

Abdominal cocoon

Background The abdominal cocoon syndrome was first described as a rare condition where part of or the whole small bowel is encased within a fibrous membrane. Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. But preoperative diagnosis can be made. Case presentation This report is of a 27-year-old Bangladeshi male who presented with increasing abdominal pain and features of subacute intestinal obstruction. He had a history appendicectomy 2 months back through grid iron incision in a peripheral hospital. Pre-operative work-up did not reveal a sac like structure encasing small intestinal loops. At computed tomography of the abdomen and pelvis, a huge cystic structure was seen encasing loops of small bowel. At laparotomy, a fibrous capsule was revealed, in which small bowel loops were encased, with the presence of interloop adhesions. A diagnosis of primary abdominal cocoon was established and extensive adhesiolysis was performed. The patient had an uneventful recovery and follow-up. No evidence of Kochs noted in the abdomen or on histopathology of tissue sent for examination. Conclusion Abdominal cocoon is a rare cause of small bowel obstruction, but should be suspected especially in cases with attacks of non strangulating obstruction in the same individual. A high index of clinical suspicion may be generated by the recurrent character of small bowel obstruction. Clinicians must rigorously pursue a preoperative diagnosis. The overall prognosis is satisfactory. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20269 Pulse Vol.5 July 2011 p.61-64

Persistent ascites due to sclerosing encapsulating peritonitis mimicking ovarian carcinoma: A case report.

Sclerosing encapsulating peritonitis, also known as 'Cocoon Syndrome', is a rare cause of bowel obstruction. The condition might be congenital or acquired and has non-specific symptomatology. Abdominal pain occurs due to the limitation of intestinal motility or segment obstruction by a thick homogenous fibrotic mantle covering the intra-peritoneal organs. Altered peritoneal fluid dynamics result in persistent ascites. Leading pathogenic theories are not well defined, but genetic factors, retrograde trans-tubal flow of causative agents, peritoneal infections, medications and peritoneal invasive procedures are all thought to play a role. There are no specific diagnostic criteria and exact diagnosis is only confirmed during surgery when the investing thick fibrous folds covering the bowel loops are visualised. We present here a case that had been suspected to have an ovarian malignancy due to a huge abdominal heterogeneous mass and ascites on preoperative diagnostic workup, but had a final diagnosis of abdominal Cocoon Syndrome made during surgery.

A Rare Cause of Intestinal Perforation in a Patient on Continuous Ambulatory Peritoneal Dialysis Therapy: Abdominal Cocoon Syndrome

Abdominal Cocoon Syndrome (ACS) or sclerosing encapsulating peritonitis is characterized by intestinal obstruction and ileus as a result of encasement of small intestines totally or partially by a thick fibrous sac. We herein present a patient undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) therapy for chronic renal failure for 3 years who developed intestinal obstruction and perforation and was subsequently diagnosed with abdominal cocoon syndrome. Abdominal cocoon should be remembered in patients on CAPD therapy. One should also be aware that clinical signs of peritonitis may not become evident in the case of intestinal perforation in patients with ACS. In such cases, computed tomography has an important role in making the diagnosis.

Coexistence of abdominal cocoon, intestinal perforation and incarcerated Meckel’s diverticulum in an inguinal hernia: A troublesome condition

Sclerosing encapsulating peritonitis (SEP) is a rare disease entity, in which the small intestine becomes encased and mechanically obstructed by a dense, fibrotic membrane. The disorder is characterized as either primary (idiopathic) or secondary to other causes. The idiopathic cases of SEP, which lack any identifiable etiology according to clinical, radiological and histopathological findings, are also reported under the designation of abdominal cocoon syndrome. The most frequent presenting symptoms of all SEP cases are nausea, vomiting, abdominal distention and inability to defecate, all of which are associated with the underlying intestinal obstruction. Persistent untreated SEP may advance to intestinal perforation, representing a life-threatening condition. However, preoperative diagnosis remains a particular clinical challenge, and most diagnoses are confirmed only when the typical fibrous membrane encasing the small intestine is discovered by laparotomy. Here, we report the clinical presentation of an 87-year-old male with signs of intestinal obstruction and the ultimate diagnosis of concurrent abdominal cocoon, right incarcerated Meckel's diverticulum, and gastrointestinal perforation in laparotomy.

English

Abdominal cocoon syndrome is characterized by encapsulation of the small bowel by a fibrous peritoneal sac. We describe the case of a middle aged male patient who presented with sub acute intestinal obstruction. Treatment involves exploratory laparotomy, excision of the sac and adhesiolysis. Early post operative small bowel obstruction is a rare entity in this disease and can be managed conservatively. It is important to have a high degree of suspicion as Abdominal cocoon syndrome has variable clinical presentation and non specific imaging findings. INTRODUCTION: Sclerosing peritoneal encapsulation is a rare developmental malformation characterized by the encasement of all or part of the small bowel by a thick, accessory peritoneal sheath [1]. It was first described by Owtschinnikow in 1907 as “peritonitis chronica fibrosa incapsulata” [2] and termed “abdominal cocoon” by Foo in 1978 [2,3] .It is characterized by a complete or partial encasement of the small bowel by a thick and fibrotic membrane (cocoons) The loops within the cocoon are normal and adherent to each other. Abdominal cocoon generally presents as recurrent acute or sub acute intestinal obstruction with or without a mass [4]. The ideal treatment is operative, with dissection of the membrane from the intestine and separation of adherent loops of the small bowel until they are laid free and return to their normal configuration. [5] CASE REPORT: A 35-year-old male presented with complains of multiple episodes of vomiting, constipation, and abdominal discomfort since twenty days. He suffered similar complaints about a month previously for which he underwent a diagnostic laparoscopy at a small nursing home, which revealed cocooning of small bowel loops. Patient was investigated for Tuberculosis of the abdomen; however ascitic fluid ADA levels and ESR were not suggestive of Tuberculosis. Physical examination revealed a mildly tender lump in the Left hypochondrium with minimal abdominal distension. There was no hyperperistalsis on auscultation of the abdomen. Patient was otherwise vitally stable and systemic examination was normal. Blood parameters were all within normal limits. X-ray erect abdomen revealed 4-5 air fluid levels; USG abdomen showed clumping of small bowel loops in the Left hypochondrium with distal small intestine free. A provisional diagnosis of sub acute intestinal obstruction was made and patient was kept nil per oral, nasogastric decompression and IV hydration was administered. CECT abdomen was done which revealed clumping of jejunal and ileal loops

Abdominal cocoon: A rare cause of intestinal obstruction

Abdominal cocoon syndrome is described as rare condition causing intestinal obstruction where a part or whole small bowel is encased in a fibrous membrane. This case report is of a 30-year-old male patient who had undergone laparoscopic appendectomy five months ago presented with history, clinical and radiological findings suggestive of intestinal obstruction. He had been having similar episodes of intestinal obstruction which gets resolved spontaneously before and after surgery. Peroperatively inner aspect of entire peritoneal cavity was lined by a membrane which was adherent in certain areas causing obstruction. Adhesiolysis was done and patient recovered well. Awareness of this rare condition along with early diagnosis with radiological guidance and surgical intervention reduces morbidity of the patient.

Abdominal Cocoon Syndrome (Idiopathic Sclerosing Encapsulating Peritonitis): How Easy Is Its Diagnosis Preoperatively? A Case Report

The abdominal cocoon syndrome (or idiopathic encapsulating peritonitis) is a rare cause of intestinal obstruction. It has been reported predominantly in adolescent girls living in tropical/subtropical region in which diagnosis is only made at laparotomy in most cases. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. The author reports a case of a female patient with recurrent intestinal obstruction treated for years but failed to settle down on conservative treatment during her last hospital admission and had to undergo surgery. Preoperative diagnosis of this syndrome as the cause of her intestinal obstruction was not made until at laparotomy, when a thick fibrotic peritoneal wrapping of the bowel in a concertina-like fashion with some adhesions was found. Excision of this membrane and adhesiolysis were carried out without any need for bowel resection, and this led to relief of the obstruction and patient's complete recovery. Awareness of this benign condition in the differential diagnosis of intestinal obstruction will result in early diagnosis and correct management and prevent unnecessary bowel resections and bad outcomes.

Abdominal cocoon syndrome: Preoperative diagnostic criteria, good clinical outcome with medical treatment and review of the literature

Sclerosing encapsulating peritonitis, or abdominal cocoon syndrome, was described firstly in young adolescent girls. It is characterized by a thick fibrotic peritoneum that wraps the bowel in a concertina-like fashion with some adhesions. We report a man with intermittent intestinal obstruction and an abdominal cocoon encasing the small bowel. Our patient had no history of peritonitisor tuberculosis. We think he had primary abdominal cocoon syndrome. To the best of our knowledge, very few male patients have been reported in the medical literature as developing this condition. We treated the patient with drug therapy, including steroidand mycophenolate mofetil, and a liquid diet program, without surgical operation. He was symptom-free on follow-up over a period of 11 months.

Ovarian cyst and abdominal cocoon syndrome

The abdominal cocoon syndrome is described as a rare entity in which part or whole of the small bowel is enclosed in a fibrous membrane. This case report is of a 35 years old woman who had a provisional diagnosis of ovarian cyst. Intraoperatively she was found to have abdominal cocoon syndrome. Laparotomy with cystectomy was done. She developed subacute intestinal obstruction 5 days later. This was managed conservatively.

Abdominal cocoon syndrome as a rare cause of mechanical bowel obstruction: report of two cases

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.

Sclerosing encapsulating peritonitis associated with propranolol usage: A case report and review of the literature

Sclerosing encapsulating peritonitis associated with propranolol usage: A case report and review of the literature

Les péritonites encapsulantes

Sclerosing peritonitis (also described as sclerosing obstructive peritonitis, encapsulating peritonitis, obliterative adhesive peritonitis, abdominal cocoon syndrome) is not well-known by the general surgeon; most reviews of this subject occur in the nephrology literature. Peritoneal dialysis and continuous hyperthermic peritoneal perfusion are the main causes. No controlled study exists to evaluate the optimal therapeutic approach. Pre-operative diagnosis is difficult since the clinical signs and radiologic findings are non-specific. Nevertheless, the diagnosis should be considered when small bowel obstruction with proximal dilatation, ascites, and thickened or calcified peritoneum are seen on imaging. The surgeon should recognize sclerosing peritonitis grossly when it is encountered and adapt his surgical strategy accordingly.